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Gemeinsam klug entscheiden – Diabetisches Fußsyndrom

Choosing wisely together—Diabetic foot syndrome

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Zusammenfassung

In diesem Beitrag werden die starken Empfehlungen (Grad A) der AWMF-Leilinien zum Thema „Nationale Versorgungsleitlinie Typ-2-Diabetes: Präventions- und Behandlungsstrategien für Fußkomplikationen (Version 2.8, Februar 2010)“ für die Bereiche weiterführende Diagnostik, therapeutische Maßnahmen und Amputation zusammengefasst dargestellt und diskutiert. Einschränkend muss erwähnt werden, dass die Gültigkeit der Leitlinien abgelaufen ist. Eine aktuelle Fassung lag bis zur Entstehung dieses Beitrags noch nicht vor, sodass sich die Autoren dieses Artikels an der letzten verfügbaren Fassung orientierten und zusätzlich Empfehlungen der aktuellen ESVS-Leitlinien CLTI berücksichtigten. Die Vergabe der Empfehlungsgrade erfolgte durch ein formales Konsensusverfahren der beteiligten Leitlinienautoren. Auf die Empfehlungen Grad B und Grad 0 wird in diesem Artikel aufgrund des geringen Empfehlungsgrads nicht eingegangen.

Abstract

In this article the strong recommendations (grade A) of the Association of the Scientific Medical Societies in Germany (AWMF) guidelines on the topic of “National treatment guidelines for type 2 diabetes: preventive and treatment strategies for foot complications” (version 2.8, February 2010) for the areas of extended diagnostics, therapeutic procedures and amputation are summarized and discussed. Restrictively, it has to be noted that the validity of the guidelines has expired. A current version was not yet available when this article was written, therefore the authors of this article used the last available version as a reference. Additionally, the current European Society for Vascular Surgery (ESVS) guidelines on chronic limb-threatening ischemia (CLTI) were also taken into account. The grades of recommendation were assigned by a formal consensus procedure between the participating authors of the guidelines. Due to the low level of recommendation, the grade B and grade 0 recommendations are not discussed in this article.

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Literatur

  1. Zylka-Menhorn V (2017) Diabetes mellitus: Inzidenz und Prävalenz steigen in Deutschland. Dtsch Arztebl 114(15):A-748 / B‑634 / C‑620

    Google Scholar 

  2. Morbach S, Lobmann R, Eckhard M, Müller E, Reike H, Risse A, Rümenapf G, Spraul M (2020) Diabetisches Fußsyndrom. Diabetologe 16:54–64

    Article  Google Scholar 

  3. Scheffler A, Rieger H (1991) O2-Inhalation und Beintieflagerung als Provokationstests fur die transkutane Sauerstoffpartialdruckmessung (tcpO2) bei fortgeschrittener peripherer arterieller Verschlusskrankheit. Vasa Suppl 33:269–270

    CAS  PubMed  Google Scholar 

  4. Podhaisky H, Hänsgen K, Taute B, Podhaisky T (2005) Duplexsonographie im distalen Extremitätenbereich zur Schweregradbeurteilung der pAVK. Perfusion 18:95–100

    Google Scholar 

  5. Manu CA, Freedman B, Rashid H, Winkley K, Edmonds ME (2020) Peripheral arterial disease located in the feet of patients with diabetes and foot ulceration demands a new approach to the assessment of ischemia. Int J Low Extrem Wounds. https://doi.org/10.1177/1534734620947979

    Article  PubMed  Google Scholar 

  6. Leiner T, Kessels AG, Nelemans PJ, Vasbinder GB, de Haan MW, Kitslaar PE, Ho KY, Tordoir JH, van Engelshoven JM (2005) Peripheral arterial disease: comparison of color duplex US and contrast-enhanced MR angiography for diagnosis. Radiology 235(2):699–708

    Article  Google Scholar 

  7. Armstrong DG, Lavery LA, Wu S, Boulton AJ (2005) Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care 28(3):551–554

    Article  Google Scholar 

  8. Faglia E, Caravaggi C, Clerici G, Sganzaroli A, Curci V, Vailati W, Simonetti D, Sommalvico F (2010) Effectiveness of removable walker cast versus nonremovable fiberglass off-bearing cast in the healing of diabetic plantar foot ulcer: a randomized controlled trial. Diabetes Care 33(7):1419–1423

    Article  Google Scholar 

  9. Frykberg RG, Lavery LA, Pham H, Harvey C, Harkless L, Veves A (1998) Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes Care 21:1714–1719

    Article  CAS  Google Scholar 

  10. Steed DL, Donohoe D, Webster MW, Lindsley L (1996) Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. J Am Coll Surg 183(1):61–64 (Diabetic Ulcer Study Group)

    CAS  PubMed  Google Scholar 

  11. Fernandez R, Griffiths R (2012) Water for wound cleansing. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003861.pub3

    Article  PubMed  Google Scholar 

  12. Chantelau E, Tanudjaja T, Altenhofer F, Ersanli Z, Lacigova S, Metzger C (1996) Antibiotic treatment for uncomplicated neuropathic forefoot ulcers in diabetes: a controlled trial. Diabet Med 13(2):156–159

    Article  CAS  Google Scholar 

  13. Hirschl M, Hirschl AM (1992) Bacterial flora in mal perforant and antimicrobial treatment with ceftriaxone. Chemotherapy 38(4):275–280

    Article  CAS  Google Scholar 

  14. O’Meara SM, Cullum NA, Majid M, Sheldon TA (2001) Systematic review of antimicrobial agents used for chronic wounds. Br J Surg 88(1):4–21

    Article  Google Scholar 

  15. Gottrup F, Apelqvist J, Bjarnsholt T, Cooper R, Moore Z, Peters EJG, Probst S (2013) EWMA document: antimicrobials and non-healing wounds. Evidence, controversies and suggestions. J Wound Care 22(5 Suppl):S1–S89

    Article  CAS  Google Scholar 

  16. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, LeFrock JL, Lew DP, Mader JT, Norden C, Tan JS (2004) Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 39(7):885–910

    Article  Google Scholar 

  17. Dormandy JA, Rutherford RB (2000) Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). Int Angiol 19(1 Suppl 1):I-304

    Google Scholar 

  18. Van Der Veen C, Neijens FS, Kanters SDJM, Mali WPTM, Stolk RP, Banga JD (2002) Angiographic distribution of lower extremity atherosclerosis in patients with and without diabetes. Diabet Med 19:366–370

    Article  Google Scholar 

  19. Bradbury AW, Adam DJ, Bell J et al (2010) Bypass versus angioplasty in severe Ischaemia of the leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg 51(5 Suppl):5S–17S (published correction appears in J Vasc Surg. 2010 Dec;52(6):1751. Bhattachary, V [corrected to Bhattacharya, V])

    Article  Google Scholar 

  20. Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R et al (2019) Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg 58(1S):S1–S109.e33. https://doi.org/10.1016/j.ejvs.2019.05.006

    Article  PubMed  Google Scholar 

  21. Haider SN, Kavanagh EG, Forlee M, Colgan MP, Madhavan P, Moore DJ, Shanik GD (2006) Two year outcome with preferential use of infrainguinal angioplasty for critical ischemia. J Vasc Surg 43(3):504–512

    Article  Google Scholar 

  22. Frykberg RG, Mendeszoon E (2000) Management of the diabetic Charcot foot. Diabetes Metab Res Rev 16(Suppl 1):S59–S65

    Article  Google Scholar 

  23. Schon LC, Easley ME, Weinfeld SB (1998) Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res 349:116–131

    Article  Google Scholar 

  24. Misuri A, Lucertini G, Nanni A, Viacava A, Belardi P (2000) Predictive value of transcutaneous oximetry for selection of the amputation level. J Cardiovasc Surg 41(1):83–87

    CAS  Google Scholar 

  25. Bollinger M, Thordarson DB (2002) Partial calcanectomy: an alternative to below knee amputation. Foot Ankle Int 23(10):927–932

    Article  Google Scholar 

  26. Volmer-Thole M, Lobmann R (2016) Neuropathy and diabetic foot syndrome. Int J Mol Sci 17(6):917

    Article  Google Scholar 

  27. Schaper NC, Andros G, Apelqvist J et al (2012) Specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot 2011. Diabetes Metab Res Rev 28(Suppl 1):236–237

    Article  Google Scholar 

  28. Lobmann R (2011) Das diabetische Fußsyndrom. Internist 52(5):539–548

    Article  CAS  Google Scholar 

  29. Robinson C, Major MJ, Kuffel C, Hines K, Cole P (2015) Orthotic management of the neuropathic foot: an interdisciplinary care perspective. Prosthet Orthot Int 39(1):73–81

    Article  Google Scholar 

  30. Broussard KC, Powers JG (2013) Wound dressings: selecting the most appropriate type. Am J Clin Dermatol 14(6):449–459

    Article  Google Scholar 

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland

    C. Uhl, A. Heller, J. Hatzl & D. Böckler

  2. Abteilung für Gefäßchirurgie, Universitätsklinikum Erlangen, Erlangen, Deutschland

    U. Rother

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  1. C. Uhl
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  2. A. Heller
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  4. J. Hatzl
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Correspondence to C. Uhl.

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Interessenkonflikt

C. Uhl, A. Heller, U. Rother, J. Hatzl und D. Böckler geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Uhl, C., Heller, A., Rother, U. et al. Gemeinsam klug entscheiden – Diabetisches Fußsyndrom. Gefässchirurgie 26, 183–187 (2021). https://doi.org/10.1007/s00772-021-00761-5

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  • DOI: https://doi.org/10.1007/s00772-021-00761-5

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